CRS-PRO and SNOT-22 correlations with type 2 inflammatory mediators in chronic rhinosinusitis

Samuel D. Racette, Alexander L. Schneider, Meera Ganesh, Julia H. Huang, David S. Lehmann, Caroline P.E. Price, Samuel G. Rodegherio, Abhita T. Reddy, Jacob G. Eide, David B. Conley, Kevin C. Welch, Robert C. Kern, Stephanie Shintani-Smith, Atsushi Kato, Robert P. Schleimer, Bruce K. Tan*

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

9 Scopus citations


Abstract: The 22-item Sino-Nasal Outcome Test (SNOT-22) and 12-item Patient Reported Outcomes in Chronic Rhinosinusitis (CRS-PRO) instrument are validated patient-reported outcomes measures in CRS. In this study we assess the correlation of these with type 2 (T2) biomarkers before and after endoscopic sinus surgery (ESS). Methods: Middle meatal mucus data were collected and the SNOT-22 and CRS-PRO were administered to 123 patients (71 CRS without nasal polyps [CRSsNP], 52 CRS with nasal polyps [CRSwNP]) with CRS before and 6 to 12 months after undergoing ESS. Interleukin (IL)-4, IL-5, IL-13, and eosinophilic cationic protein (ECP) were measured using a multiplexed bead assay and enzyme-linked immunoassay. Pre- and post-ESS SNOT-22 and CRS-PRO were compared with T2 biomarkers. Results: Before ESS neither PROM correlated with any biomarker. After ESS, CRS-PRO showed a correlation with 2 mediators (IL-5 and IL-13: p = 0.012 and 0.003, respectively) compared with none for the SNOT-22. For CRSwNP patients, pre-ESS CRS-PRO and SNOT-22 correlated with IL-4 (p = 0.04 for both). However, after ESS, CRS-PRO correlated with 3 biomarkers (IL-5, IL-13, and ECP: p = 0.02, 0.024, and 0.04, respectively) and SNOT-22 with 2 biomarkers (IL-5 and IL-13: p = 0.038 and 0.02, respectively). There were no significant relationships between any of the T2 biomarkers pre- or post-ESS among patients with CRSsNP. Exploratory analyses of the subdomains showed the SNOT-22 rhinologic and CRS-PRO rhinopsychologic subdomains correlated better with the T2 biomarkers. On individual item analysis, IL-13 correlated significantly post-ESS with 8 of 12 items on the CRS-PRO vs 6 of 22 items on the SNOT-22. Conclusion: The CRS-PRO total score showed a significant correlation with T2 biomarkers especially when assessed post-ESS and among CRSwNP patients.

Original languageEnglish (US)
Pages (from-to)1377-1386
Number of pages10
JournalInternational Forum of Allergy and Rhinology
Issue number11
StatePublished - Nov 2022


  • CRSsNP
  • CRSwNP
  • SNOT-22
  • patient-reported outcomes
  • type 2 inflammation

ASJC Scopus subject areas

  • Immunology and Allergy
  • Otorhinolaryngology


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